儿童急性心肌炎：治疗概述及最新专利。

Acute Myocarditis in Children: An Overview of Treatment and Recent Patents.

机构信息

Department of Paediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Kowloon Bay, Kowloon, Hong Kong.

Department of Pediatrics, The University of Calgary and The Alberta Children's Hospital, Calgary, Alberta, Canada.

出版信息

Recent Pat Inflamm Allergy Drug Discov. 2020;14(2):106-116. doi: 10.2174/1872213X14666200204103714.

DOI:10.2174/1872213X14666200204103714

PMID:32013855

Abstract

BACKGROUND

Pediatric myocarditis is rare but challenging. This overview summarized the current knowledge and recent patents on childhood myocarditis.

METHODS

Clinical queries and keywords of "myocarditis" and "childhood" were used as search engine.

RESULTS

Viral infections are the most common causes of acute myocarditis. Affected children often have a prodrome of fever, malaise, and myalgia. Clinical manifestations of acute myocarditis in children can be nonspecific. Some children may present with easy fatigability, poor appetite, vomiting, abdominal pain, exercise intolerance, respiratory distress/tachypnea, dyspnea at rest, orthopnea, chronic cough with wheezing, chest pain, unexplained tachycardia, hypotension, syncope, and hepatomegaly. Supraventricular arrhythmias, ventricular arrhythmias, and heart block may be present. A subset of patients have fulminant myocarditis and present with cardiovascular collapse, which may progress to severe cardiogenic shock, and even death. A high index of suspicion is crucial to its diagnosis and timely management. Cardiac magnetic resonance imaging is important in aiding clinical diagnosis while, endomyocardial biopsy remains the gold standard. The treatment consists of supportive therapy, ranging from supplemental oxygen and fluid restriction to mechanical circulatory support. Angiotensinconverting enzyme inhibitors, angio-tensin II receptor blockers, β-blockers, and aldosterone antagonists might be used for the treatment of heart failure while, immunosuppression treatments remain controversial. There are a few recent patents targeting prevention or treatment of viral myocarditis, including an immunogenic composition comprising a PCV-2 antigen, glutathione-S-transferase P1, neuregulins, NF-[kappa] B inhibitor, a pharmaceutical composition which contains 2-amino-2- (2- (4-octyl phenyl) - ethyl) propane 1,3-diol, a composition containing pycnojenol, Chinese herbal concoctions, and a Korean oral rapamycin. Evidence of their efficacy is still lacking.

CONCLUSION

This article reviews the current literature regarding etiology, clinical manifestations, diagnosis, and management of acute myocarditis in children.

摘要

背景

小儿心肌炎罕见但极具挑战性。本综述总结了目前关于儿童心肌炎的知识和最近的专利。

方法

使用“心肌炎”和“儿童”的临床查询和关键词作为搜索引擎。

结果

病毒感染是急性心肌炎最常见的原因。受影响的儿童通常有发热、不适和肌痛前驱期。儿童急性心肌炎的临床表现可能不典型。一些儿童可能表现为易疲劳、食欲不振、呕吐、腹痛、运动不耐受、呼吸困难/呼吸急促、静息时呼吸困难、慢性咳嗽伴喘息、胸痛、不明原因的心动过速、低血压、晕厥和肝肿大。可能出现室上性心律失常、室性心律失常和心脏传导阻滞。一部分患者有暴发性心肌炎，表现为心血管衰竭，可能进展为严重心源性休克，甚至死亡。高度怀疑是其诊断和及时治疗的关键。心脏磁共振成像对辅助临床诊断很重要，而心内膜心肌活检仍然是金标准。治疗包括支持性治疗，从补充氧气和限制液体到机械循环支持。血管紧张素转换酶抑制剂、血管紧张素 II 受体阻滞剂、β受体阻滞剂和醛固酮拮抗剂可能用于心力衰竭的治疗，而免疫抑制治疗仍存在争议。有一些针对预防或治疗病毒性心肌炎的最新专利，包括包含 PCV-2 抗原、谷胱甘肽 S-转移酶 P1、神经调节素、NF-[kappa] B 抑制剂的免疫原性组合物、含有 2-氨基-2-（2-（4-辛基苯基）-乙基）丙烷 1,3-二醇的药物组合物、包含 pycnojenol 的组合物、中药方剂和一种韩国口服雷帕霉素。它们的疗效证据仍然缺乏。